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NEBRASKA - <br />Good Lite. Greet Service, <br />awr.wn ata nx«ur <br />NE Sec of State - Roberta Evnen <br />Filing Document #: 2103001530-3 Pages: 1 <br />Debtor Name: ROSA M PORTILLO <br />Filing Date and Time: 03/30/2021 09:52 AM <br />Notice of State Tax Lien <br />202102607 <br />This Notice of State Tax Lien is issued by the Nebraska <br />Department of Revenue for unpaid taxes administered by the Tax <br />Commissioner. Taxes, including penalties, interest, and costs, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after demand.These taxes are a lien for all property located <br />in the county and rights to property owned by the taxpayer or <br />acquired beton the expiration of this Iien.This lien will expire and <br />become unenforceable 10 years after the date of recording if no <br />continuation statement is recorded on or prior to the expiration of <br />the previous lien or continuation statement. <br />PLEASE DO NOT WRITE INTIM SPACE <br />Date of <br />Assessment <br />Nebraska 10 Number <br />12513466 <br />Federal 10 Number <br />811806628 <br />Interest <br />Lien Serial Number <br />12170239 <br />Lien Feed with: <br />®ster' 01 Deeds ©Cy t <br />Social Security Number <br />XXX -XX -7529 <br />SPoueds Sodel Security hkamrer <br />05/01/2019 <br />Dab or Lien <br />March 15,2021 <br />Lien Type: <br />ā¯‘corrected <br />County <br />HALL <br />.. <br />t <br />!;3Ona ā¯‘continuation <br />Business Name and Location Addeo** <br />axpsyer Name and Mailing <br />ROSA M PORT1LLO <br />EL BUEN SABOR <br />111 W 13TH STREET <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />04/01/2018 -03/31/2019 <br />05/01/2019 <br />3,653.00 <br />334.26 <br />403.48 <br />.00 <br />4,390.74 <br />Sales <br />04/01/2019- 12/31/2019 <br />08/03/2020 <br />3,158.28 <br />283.24 <br />221.91 <br />.00 <br />3,663.43 <br />Sales <br />01/01/2020-07/3112020 <br />10/01/2020 <br />2,518.99 <br />203.72 <br />91.88 <br />.00 <br />2,814.59 <br />Total <br />10,868.76 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue hes compared with 1he taws or the Stab of Naoraaka 91 determining the amount shown to be due, <br />end that the taxpayer has ta0sd to pay aro amount due seer demand. This Notice of Stab Tax Lien is an effective gen and serves b conbue the priority o1 <br />thefflatel interest0 the affected property of the anonym. <br />t e <br />Revenue Agent 03/09/2021 402-471-5956 <br />Tab <br />Revenue Senior Agent <br />rob <br />Date Phone Number <br />4.404.1974 010. 62018 &0in as 4449.19 4 Rao. 62013 <br />